Definition: Ménière’s disease is an idiopathic inner ear disease that presents with recurrent episodes of rotational vertigo, fluctuating sensorineural hearing loss, tinnitus and a feeling of fullness in the ear. The underlying pathologic change in Ménière’s disease is fluid accumulation in the membranous vagus.
Diagnosis based on
1. 2 or more episodes of vertigo, lasting from 20 min to several hours. It is often accompanied by autonomic dysfunction and balance disorders. No loss of consciousness.
2. Fluctuating hearing loss, mostly low-frequency hearing loss in the early stage, with progressive hearing loss gradually increasing. At least one pure tone audiometry for sensorineural hearing loss, can appear the phenomenon of reverberation.
3.It may be accompanied by tinnitus and/or a sense of ear swelling and fullness.
4.Vestibular function examination: there may be spontaneous nystagmus and/or abnormal vestibular function.
5.Exclude vertigo caused by other diseases, such as benign paroxysmal positional vertigo, vaginitis, vestibular neuritis, drug-induced vertigo, sudden deafness, inadequate blood supply to the vertebral basilar artery and intracranial occupying lesions.
Clinical stages
Early stage: normal hearing or mild low-frequency hearing loss in the intermittent period.
Middle stage: intermittent hearing loss at both low and high frequencies except for 2kHz.
Late stage: full frequency hearing loss of moderate to severe or more, without hearing fluctuations.
Suspicious diagnosis (Meniere’s disease pending diagnosis)
1 .Only 1 episode of vertigo with pure tone audiometry for sensorineural hearing loss with tinnitus and a sense of ear fullness.
2, 2 or more episodes of vertigo lasting from 20 minutes to several hours. Hearing is normal without tinnitus and fullness.
3, Fluctuating low-frequency sensorineural hearing loss. The phenomenon of reverberation may occur. No obvious vertigo attack.
4 .Exclude vertigo caused by other diseases, such as benign paroxysmal positional vertigo, vaginitis, vestibular neuritis, drug-induced vertigo, sudden deafness, inadequate blood supply to the vertebral basilar artery and intracranial occupying lesions.
Efficacy assessment.
1. Vertigo assessment: The average number of vertigo attacks per month in the last six months after 2 years of treatment was compared with the average number of attacks per month in the six months before treatment, according to.
Score obtained = number of attacks per month after treatment / number of attacks per month before treatment
There are 5 grades, namely
Grade A: 0 (complete control, not to be interpreted as “cure”)
Grade B: 1~40 (basic control)
Grade C: 41~80 (partial control)
Grade D: 81~120 (uncontrolled)
Grade E: >120 (aggravation)
2.Hearing evaluation: The average of the worst 0.25, 0.5, 1, 2 and 3 kHz hearing thresholds in the 6 months before treatment minus the average of the worst corresponding frequency hearing thresholds in the 18~24 months after treatment was evaluated.
Grade A: Improvement >30 dB or hearing threshold <20 dB HL at each frequency;
Class B: Improvement of 15-30 dB;
Grade C: improvement of 0~14 dB (invalid)
Grade D: improvement <0 (deterioration)
If bilateral Ménière’s disease is diagnosed, it should be evaluated separately.